Publications

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    ABSTRACT: Bedside computing may lead to increased hospital-acquired infections mediated by computer input devices handled immediately after patient contact. We compared 2 decontamination methods in 2 types of wards. We found high baseline contamination rates, which decreased following decontamination, but the rates remained unacceptably high. Decontamination was more effective in intensive care units compared with medical wards and when using alcohol-based impregnated wipes compared with quaternary ammonium-based impregnated wipes. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Infection Control. 11/2014;
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    ABSTRACT: Background: Cutaneous leishmaniasis (CL) is an endemic zoonosis in southern Israel. In recent years, substantial urbanization is taking place in this region. Introduction of populations into endemic foci was previously reported to facilitate human CL outbreaks. Our aim was to describe a continuous CL outbreak in southern Israel, through laboratory reports of CL diagnosis. Methods: The Soroka University Medical Center Parasitology laboratory is the major laboratory confirming CL cases in our region. Data regarding patients referred to the hospital for CL diagnosis were retrospectively collected. Cases were defined by microscopic findings of skin lesions biopsies. Results: Annual number of cases sent for CL laboratory confirmation increased from a mean of 77±9 in the years 2007-2010 to 178, 327 and 528 in the years 2011, 2012 and 2013, respectively. The respective increase in annual CL confirmed/positive cases was from 36±12 to 117, 171 and 282, leading to respective increase in CL rate (per 100,000) from 5.8±1.9 to 18.4, 26.3 and 42.7. The outbreak was mainly (>60%) observed in the north-west area of the region. Conclusions: In conclusion, a seven-fold increase in laboratory-confirmed CL was observed in southern Israel in 2007-2013, probably reflecting a bigger outbreak, possibly related to urban expansion bordering with CL foci.
    Scandinavian Journal of Infectious Diseases 10/2014; · 1.71 Impact Factor
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    ABSTRACT: Insights about patterns of system use are often gained through the analysis of system log files, which record the actual behavior of users. In a clinical context, however, few attempts have been made to typify system use through log file analysis. The present study offers a framework for identifying, describing, and discerning among patterns of use of a clinical information retrieval system. We use the session attributes of volume, diversity, granularity, duration, and content to define a multidimensional space in which each specific session can be positioned. We also describe an analytical method for identifying the common archetypes of system use in this multidimensional space. We demonstrate the value of the proposed framework with a log file of the use of a health information exchange (HIE) system by physicians in an emergency department (ED) of a large Israeli hospital. The analysis reveals five distinct patterns of system use, which have yet to be described in the relevant literature. The results of this study have the potential to inform the design of HIE systems for efficient and effective use, thus increasing their contribution to the clinical decision-making process.
    Journal of Biomedical Informatics 07/2014; · 2.13 Impact Factor
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    ABSTRACT: Background. The mass media plays an important role in public health behavior. Purpose. The objective of the present study was to investigate the effect of mass media coverage of the H1N1 pandemic on the number of emergency department (ED) visits and hospital admission rates. Methods. An ecological study of ED visits to 8 general Israeli hospitals due to influenza-like illness during the period June-October 2009 was performed. Data on the number of visits per day for children and adults and daily hospitalization rates were analyzed. Associations with the estimated value of H1N1-related publications and weekly reports from nationwide sentinel clinics were assessed. The analysis was performed in 2012-2013. Results. There were 55,070 ED visits due to influenza-like illness during the study period. The overall number of media reports was 1,812 (14.3% radio broadcasts, 9.8% television broadcasts, 27.5% newspaper articles, and 48.5% major website reports). The overall estimated value of advertising of publications was $16,399,000, excluding the Internet. While H1N1 incidence recorded by Israeli sentinel clinics showed no association with mass media publications, peaks of media reports were followed by an increase in the number of ED visits, usually with a delay of 3 days (P = .005). This association was noted in children (P < .001) but not in adults (P > .1), with a corresponding decrease in hospital admission rates. Publications' framing had no association with ED visits. Conclusions. During the 2009 H1N1 influenza outbreak in Israel, an increase in mass media coverage was associated with an increase in pediatric ED visits.
    Infection Control and Hospital Epidemiology 06/2014; 35(6):709-16. · 4.02 Impact Factor
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    ABSTRACT: BACKGROUND: Two distinct ethnic groups live in Southern Israel: urban Jews and rural Bedouin Arabs. These groups differ in their socioeconomic status, culture and living environment, and are treated in a single regional tertiary care hospital. We hypothesized that these two ethnic groups have different patterns of sepsis-related intensive care admissions. METHODS: The study included all adult patients admitted to the Soroka University Medical Center Intensive Care Units between January 2002 and December 2008, with a diagnosis of sepsis. Demographic data, medical history, and hospitalization and outcomes data were obtained. Primary outcome was all-cause mortality. RESULTS: Jewish patients admitted to the ICU (1343, 87%) were on average 17years older than Bedouin Arabs (199, 13%). For the population <65years, Bedouin Arabs had slightly higher age-adjusted prevalence of ICU sepsis admissions than Jewish patients (39.5 vs. 43.0, p=0.25), while for the population >65years there was a reverse trend (21.8 vs. 19.8 p=0.49). There were no differences in the type of organ failure, sepsis severity or length of hospitalization between the two groups. Twenty eight days/in-hospital mortality was 33.9% in Bedouin Arabs vs. 45.5% in Jews, p=0.004. Following adjustment for comorbidities, age and severity of the disease, survival was unrelated to ethnicity, both at 28days (odds ratio for Bedouin Arabs 0.86, 95% CI 0.66-1.24) and following hospital discharge (hazard ratio 0.86, 95% 0.67-1.09). CONCLUSIONS: Sepsis-related ICU admissions are more prevalent among Bedouin Arabs at younger age compared with the Jewish population. Adjusted for confounders, ethnicity does not influence prognosis.
    European Journal of Internal Medicine 10/2012; · 2.30 Impact Factor
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    ABSTRACT: To estimate in-hospital, 1-yr, and long-term mortality and to assess time trends in incidence and outcomes of sepsis admissions in the intensive care unit. A population-based, multicenter, retrospective cohort study. Patients hospitalized with sepsis in the intensive care unit in seven general hospitals in Israel during 2002-2008. None. Survival data were collected and analyzed according to demographic and background clinical characteristics, as well as features of the sepsis episode, using Kaplan-Meier approach for long-term survival. A total of 5,155 patients were included in the cohort (median age: 70, 56.3% males; median Charlson comorbidity index: 4). The mean number of intensive care unit admissions per month increased over time, while no change in in-hospital mortality was observed. The proportion of patients surviving to hospital discharge was 43.9%. The 1-, 2-, 5-, and 8-yr survival rates were 33.0%, 29.8%, 23.3%, and 19.8%, respectively. Mortality was higher in older patients, patients with a higher Charlson comorbidity index, and those with multiorgan failure, and similar in males and females. One-year age-standardized mortality ratio was 21-fold higher than expected, based on the general population rates. Mortality following intensive care unit sepsis admission remains high and is correlated with underlying patients' characteristics, including age, comorbidities, and the number of failing organ systems.
    Critical care medicine 03/2012; 40(3):855-60. · 6.37 Impact Factor
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    ABSTRACT: To assess the effectiveness of selective digestive decontamination (SDD) for eradicating carbapenem-resistant Klebsiella pneumoniae (CRKP) oropharyngeal and gastrointestinal carriage. A randomized, double-blind, placebo-controlled trial with 7 weeks of follow-up per patient. A 1,000-bed tertiary-care university hospital. Adults with CRKP-positive rectal swab cultures. Patients were blindly randomized (1 :1) over a 20-month period. The SDD arm received oral gentamicin and polymyxin E gel (0.5 g 4 times per day) and oral solutions of gentamicin (80 mg 4 times per day) and polymyxin E (1 x 10(6) units 4 times per day for 7 days). The placebo arm received oral placebo gel 4 times per day and 2 placebo oral solutions 4 times per day for 7 days. Strict contact precautions were applied. Samples obtained from the throat, groin, and urine were also cultured. Forty patients (mean age ± standard deviation, 71 ± 16 years; 65% male) were included. At screening, greater than or equal to 30% of oropharyngeal, greater than or equal to 60% of skin, and greater than or equal to 35% of urine cultures yielded CRKP isolates. All throat cultures became negative in the SDD arm after 3 days (P < .0001). The percentages of rectal cultures that were positive for CRKP were significantly reduced at 2 weeks. At that time, 16.1% of rectal cultures in the placebo arm and 61.1% in the SDD arm were negative (odds ratio, 0.13; 95% confidence interval, 0.02-0.74; P < .0016). A difference between the percentages in the 2 arms was still maintained at 6 weeks (33.3% vs 58.5%). Groin colonization prevalence did not change in either arm, and the prevalence of urine colonization increased in the placebo arm. This SDD regimen could be a suitable decolonization therapy for selected patients colonized with CRKP, such as transplant recipients or immunocompromised patients pending chemotherapy and patients who require major intestinal or oropharyngeal surgery. Moreover, in outbreaks caused by CRKP infections that are uncontrolled by routine infection control measures, SDD could provide additional infection containment.
    Infection Control and Hospital Epidemiology 01/2012; 33(1):14-9. · 4.02 Impact Factor
  • European Journal of Internal Medicine 10/2011; 22. · 2.30 Impact Factor
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    ABSTRACT: The Dead Sea area is an excellent and unique resort for patients suffering from a wide range of inflammatory and non-inflammatory joint diseases. Factors contributing to the beneficial effect are the high concentration of salts and minerals in the Dead Sea water and in the water from springs in the area, medical mud, and the unique climatic conditions including high barometric pressure, relative low humidity and high temperatures. This review describes the various balneotherapy modalities and the existing body of research describing their utility. Balneotherapy significantly improves most patients' conditions and in some cases leads to complete remission of several months duration. Although of importance, balneotherapy is not curative. An important advantage of balneotherapy is the lack of serious adverse effects, and, in contrast to some physicians' beliefs, the scarcity of contraindications for therapy at the Dead Sea area.
    Harefuah 03/2010; 149(3):175-9, 193.
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    ABSTRACT: Atherosclerotic disease is common in systemic lupus erythematosus and is the result of multiple pathogenic mechanisms that include traditional risk factors as well as SLE-related factors. Endothelial dysfunction and arterial stiffness contribute significantly to the atherogenic process. Dobutamine stress echocardiogram has not been shown to detect subclinical coronary artery disease; however, the high percentage of left ventricular outflow gradient requires further evaluation and follows-up studies.
    The Israel Medical Association journal: IMAJ 02/2008; 10(1):43-4. · 0.98 Impact Factor
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    ABSTRACT: Myocardial injury is frequently unrecognized in intensive care unit (ICU) patients. Cardiac troponin I (cTnI), a surrogate of myocardial injury, has been shown to correlate with outcome in selected groups of patients. We wanted to determine if cTnI level measured upon admission is an independent predictor of mortality in a heterogeneous group of critically ill medical patients. We conducted a prospective observational cohort study; 128 consecutive patients admitted to a medical ICU at a tertiary university hospital were enrolled. cTnI levels were measured within 6 h of admission and were considered positive (>0.7 ng/ml) or negative. A variety of clinical and laboratory variables were recorded. Both cTnI positive and negative groups were similar in terms of age, sex and pre-admission co-morbidity. In a univariate analysis, positive cTnI was associated with increased mortality (OR 7.0, 95% CI 2.44-20.5, p < 0.001), higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and a higher rate of multi-organ failure and sepsis. This association between cTnI and mortality was more pronounced among elderly patients (>65 years of age). Multivariate analysis controlling for APACHE II score revealed that elevated cTnI levels are not independently associated with 28-day mortality. In critically ill medical patients, elevated cTnI level measured upon admission is associated with increased mortality rate. cTnI does not independently contribute to the prediction of 28-day mortality beyond that provided by APACHE II.
    Critical care (London, England) 09/2005; 9(4):R390-5. · 4.72 Impact Factor
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    ABSTRACT: The efficacy of spa therapy in ankylosing spondylitis has not been investigated extensively. To study the efficacy of balneotherapy and climatic therapy (climatotherapy) at the Dead Sea area in patients with ankylosing spondylitis. In a single-blind randomized controlled study, 28 patients suffering from ankylosing spondylitis were allocated into two groups of 14 patients each. The first group (the combined treatment group) received balneotherapy (mud packs and sulfur pool) and exposure to the unique climatic conditions of the Dead Sea. The second group (the climatotherapy group) used the fresh water pool and experienced the same climatic conditions. The duration of treatment was 2 weeks and the follow-up period 3 months. For both patient groups a significant improvement was found in the outcome measures: Bath AS Disease Activity Index (P = 0.002), VisuarAnalog Scale for pain (P = 0.002) and VAS for spinal movement (P = 0.011). The variability was explained by the effect of time (within group effect) rather than the type of treatment (between group effect). Quality of life, assessed by the SF-36 questionnaire, was very low prior to the study, but improved in terms of pain amelioration in the combined treatment group. Climatotherapy at the Dead Sea area can improve the condition of patients suffering from long-standing ankylosing spondylitis.
    The Israel Medical Association journal: IMAJ 08/2005; 7(7):443-6. · 0.98 Impact Factor
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    Shlomi Codish, Richard N Shiffman
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    ABSTRACT: Ambiguity and vagueness in clinical practice guidelines reduce the likelihood of clinician adherence. They lead to inconsistent interpretation and, in turn, to inappropriate practice variation and medical errors. Resolving ambiguity and vagueness is an essential step in the computerized implementation of clinical practice guidelines. Successful resolution of ambiguity and vagueness requires an understanding of their characteristics, yet ambiguity and vagueness have not been differentiated, classified and described in medical context. In this paper, we propose a tri-axial model to describe ambiguity and vagueness in clinical practice guidelines: differentiation of true ambiguity from vagueness, classification of ambiguity and vagueness, intentionality and components involved. Our goals in introducing this model are: (a) to provide guidance to guideline authors to enable them to reduce inadvertent use of ambiguous or vague language, (b) to improve transparency when vague language is used deliberately and (c) to create a framework for the development of tools to apply the model during authoring and implementation of clinical practice guidelines.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 02/2005;
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    ABSTRACT: Medical students use many forms of medical electronic resources (MER) during clinical clerkships. Such resources may be inaccurate, irrelevant or inappropriate, yet most medical students do not receive guidance on the use of MER. During the earliest clinical clerkship we gave a series of seminars and assignments on the use of MER. These were well accepted and were followed by increased knowledge in the use of MER.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 02/2005;
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    ABSTRACT: The aim of this study was to evaluate the efficacy of home treatment with mud compresses for the hands of patients with rheumatoid arthritis (RA). Forty-five patients suffering from RA were enrolled in a double-blind, randomized, controlled study. Twenty-two were treated with true mud compresses (treatment group) and 23 were treated with attenuated mud compresses (control group). The compresses were applied in the patients' homes five times a week during a 3-week period. Patients were assessed four times: at baseline, upon completion of the 3-week treatment period, 1 month after the treatment, and 3 months after conclusion of the treatment period. Positive response was defined as reductions of 30% or more in the number of tender and swollen joints, 20% or more in physician global assessment of disease activity, and 20% or more in patient global assessment of the severity of joint pain. In the treatment group, significant reductions in the number of swollen and tender joints and patients' global assessments of pain severity was observed at all post-treatment assessments. Significant improvement in the scores of physician global assessment was seen at the end of therapy and 1 month later. In the control group, no improvement in the number of swollen and tender joints or physician global assessment was found in any post-treatment evaluation. However, a significant reduction in patient global assessment of joint pain severity was reported at the end of therapy and 3 months after concluding treatment. Treatment with mud compresses relieves pain affecting the hands and reduces the number of swollen and tender joints in the hands of patients suffering from RA. This treatment can augment conventional medical therapy in these patients.
    Rheumatology International 02/2005; 25(1):49-54. · 2.21 Impact Factor
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    The Israel Medical Association journal: IMAJ 10/2004; 6(9):562-3. · 0.98 Impact Factor
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    ABSTRACT: Dobutamine stress echocardiography (DSE) is an accurate noninvasive test used for the diagnosis and evaluation of patients with known or suspected coronary artery disease (CAD). The aim of this study was to determine the rate of positive findings in DSE, to define the echocardiographic and clinical characteristics of women with systemic lupus erythematosus (SLE) and to evaluate the safety of DSE in SLE patients. Thirty consecutive SLE patients were enrolled in the study and underwent DSE study. The mean age of patients was 44 years (range 20-76). Mean duration of SLE was 8.1 years and mean SLEDAI was 5.5. None of the DSE tests performed were positive for myocardial ischaemia. A left ventricular outflow gradient (LVOG) was found in 15/28 (54%) patients who completed the test, a result higher than the reported 20% prevalence of this finding in the literature. There were no significant differences in baseline characteristics between patients who developed a gradient and patients in whom a gradient was not found. There were no significant adverse effects during the study. In the general population, LVOG has been reported to be associated with an increased rate of chest discomfort and with a significantly lower prevalence of CAD. Whether this is true for SLE patients requires further study.
    Lupus 02/2004; 13(2):101-4. · 2.78 Impact Factor
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    ABSTRACT: Mud pack therapy is an alternative mode of treatment for rheumatic diseases. It is based on the application of heated mud packs to the entire body or to specific areas, such as over joints. The aim of the current study was to evaluate the efficacy of treatment with mud compresses at patients' homes for osteoarthritis of the knee. Fifty-eight patients with osteoarthritis of the knee were enrolled in a prospective, double-blinded, controlled study. Forty patients were treated with natural mineral-rich mud compresses and 18 patients were treated with mineral-depleted mud compresses. Mud compresses were applied 5 times each week during 3 weeks for a total of 15 treatments. Patients were assessed at baseline, at completion of the 3-week treatment period, and twice after the conclusion of the treatment period-after 1 month and after 3 months. The main outcome measures were the Lequesne Index of severity of knee osteoarthritis, patient self-assessment of pain, and severity of knee pain on a visual analog scale. A reduction of 20% or more in the pain scores was considered clinically significant. In the group treated with natural mud compresses, a significant reduction in knee pain was observed at all assessments. Similarly, improvement in the Lequesne Index was seen at the end of therapy and a month after treatment. In the control group, given mineral-depleted mud compresses, no significant change in knee pain was seen at any assessment. Improvement in the Lequesne Index was seen 1 and 3 months after completion of the therapy, but not at the end of therapy. Seventy-two percent of the patients in the treatment group had an improvement of >20% in self-assessment of knee pain, compared with 33% in the control group (p = 0.005). The data suggest that treatment with mud compresses, but only in their natural form, temporarily relieves pain in patients with osteoarthritis of the knees. We believe that treatment with mud compresses might augment conventional medical therapy in these patients.
    JCR Journal of Clinical Rheumatology 09/2002; 8(4):197-203. · 1.18 Impact Factor
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    ABSTRACT: Balneotherapy has been successfully used to treat various rheumatic diseases, but has only recently been evaluated for the treatment of fibromyalgia. Since no effective treatment exists for this common rheumatic disease, complementary methods of treatment have been attempted. To assess the effectiveness of balneotherapy at the Dead Sea area in the treatment of patients suffering from both fibromyalgia and psoriatic arthritis. Twenty-eight patients with psoriatic arthritis and fibromyalgia were treated with various modalities of balneotherapy at the Dead Sea area. Clinical indices assessed were duration of morning stiffness, number of active joints, a point count of 18 fibrositic tender points, and determination of the threshold of tenderness in nine fibrositic and in four control points using a dolorimeter. The number of active joints was reduced from 18.4 +/- 10.9 to 9 +/- 8.2 (P < 0.001). The number of tender points was reduced from 12.6 +/- 2 to 7.1 +/- 5 in men (P < 0.003) and from 13.1 +/- 2 to 7.5 +/- 3.7 in women (P < 0.001). A significant improvement was found in dolorimetric threshold readings after the treatment period in women (P < 0.001). No correlation was observed between the reduction in the number of active joints and the reduction in the number of tender points in the same patients (r = 0.2). Balneotherapy at the Dead Sea area appears to produce a statistically significant substantial improvement in the number of active joints and tender points in both male and female patients with fibromyalgia and psoriatic arthritis. Further research is needed to elucidate the distinction between the benefits of staying at the Dead Sea area without balneotherapy and the effects of balneotherapy in the study population.
    The Israel Medical Association journal: IMAJ 02/2001; 3(2):147-50. · 0.98 Impact Factor
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    ABSTRACT: We describe a 73-year-old HIV negative patient who presented with symptomatic hypoglycemia. Over the course of several months she was diagnosed with three human herpesvirus-8 related diseases: multicentric Castleman's disease, primary effusion lymphoma and Kaposi's sarcoma. No improvement was observed following cytotoxic therapy and she died 16 months after her initial presentation. The etiology of the hypoglycemia remained obscure over the course of this patient's disease. This case is the first report of a patient with three human herpesvirus-8 related diseases, and the first report of severe hypoglycemia as the presenting symptom of any of these diseases.
    American Journal of Hematology 01/2001; 65(4):310-4. · 4.00 Impact Factor

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